Transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy versus endoscopic forceps biopsy in the diagnosis of complex rectal lesions

Background

The preoperative pathological diagnosis of rectal lesions is crucial for formulating treatment plans. For subepithelial lesions (SELs) and larger lesions with necrosis of the rectum, endoscopic forceps biopsy (EFB) cannot provide an accurate pathological diagnosis in most cases. By comparing the efficacy and safety of transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy (TRCEUS-TP-CNB) and EFB, this study explored the value of TRCEUS-TP-CNB in the diagnosis of complex rectal lesions, such as SELs.

Methods

A retrospective, cross-sectional study was conducted with 32 consecutive patients with complex rectal lesions admitted to our hospital from May 2016 to June 2022. Clinical, ultrasound, and pathological data were collected from these patients who underwent EFB followed by TRCEUS-TP-CNB.

Results

The success rate of EFB was 21.88% (7/32) and that of TRCEUS-TP-CNB was 93.75% (30/32). No significant complications were observed for either biopsy method. Factors affecting the success rate of EFB included the lesion width (cm) (1.90±0.62 vs. 4.26±2.40, P<0.001) and lesion thickness (cm) (1.29±0.51 vs. 2.96±1.75, P<0.001). The success rate of TRCEUS-TP-CNB was not affected by these factors. In the paired study of TRCEUS-TP-CNB and EFB, the times of samples per person (1 vs. 2.14±0.90, P=0.015), number of specimens per sample (8.27±1.93 vs. 3.31±1.67, P<0.001), lesion width (cm) (3.79±2.42 vs. 1.90±0.62, P=0.001), and lesion thickness (cm) (2.64±1.75 vs. 1.29±0.51, P=0.001) were the factors affecting the difference of the sampling success rate. In the SELs, the success rate of EFB was 10% (1/10) and that of TRCEUS-TP-CNB was 100% (10/10), and the difference between the two groups was statistically significant (P=0.004).

Conclusions

TRCEUS-TP-CNB is an effective biopsy method for complex rectal lesions. The success rate of EFB is lower in the larger lesions. Compared with EFB, TRCEUS-TP-CNB required fewer times of samples be taken and obtained more specimens. For larger lesions and SELs of the rectum, TRCEUS-TP-CNB is expected to become one of the preferred biopsy methods.

Compared with SonoVue® LR-5, Sonazoid® modified LR-5 has better diagnostic sensitivity for hepatocellular carcinoma: a systematic review and meta-analysis

Background

The contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) is a standardized system for reporting liver nodules in patients at risk of developing hepatocellular carcinoma (HCC) and is only recommended for pure blood pool agents such as SonoVue®. A modified LI-RADS was proposed for Sonazoid®, a Kupffer cell-specific contrast agent. This meta-analysis was conducted to compare the diagnostic efficiency of the CEUS LI-RADS for SonoVue® and the modified LI-RADS for Sonazoid®.

Methods

The PubMed, Medline, Web of Science, Embase, and Cochrane Library databases were systematically searched to retrieve studies on the diagnostic efficiency of the CEUS LI-RADS algorithms in diagnosing HCC using SonoVue® and/or Sonazoid® from January 2016 to June 2023. Histopathology or imaging follow-up served as the reference standards. Only articles published in English on retrospective or prospective studies with full reports were included in the meta-analysis. A bivariate random-effects model was used. Data pooling, meta-regression, and sensitivity analysis were performed for the meta-analysis. Deeks' funnel plot asymmetry test was used to evaluate publication bias, and the QUADAS-2 tool was used to assess the methodological quality of eligible studies.

Results

In total, 26 studies comprising 8,495 patients with 9,244 lesions were included in the meta-analysis. The pooled data results for SonoVue® LI-RADS category 5 (LR-5) and Sonazoid® modified LR-5 were as follows: pooled sensitivity: 0.68 [95% confidence interval (CI): 0.64-0.73, I2=89.20%; P<0.01] and 0.82 (95% CI: 0.74-0.87, I2=85.39%; P<0.01) (P<0.05); pooled specificity: 0.93 (95% CI: 0.90-0.96, I2=86.52%; P<0.01) and 0.86 (95% CI: 0.79-0.91, I2=59.91%; P=0.01) (P<0.05); pooled area under the curve (AUC): 0.86 (95% CI: 0.82-0.89) and 0.91 (95% CI: 0.88-0.93) (P<0.05), respectively. The meta-regression analysis revealed that the study design, subject enrollment method, and reference standard contributed to the heterogeneity of SonoVue® LR-5, and the number of lesions was a source of heterogeneity for Sonazoid® modified LR-5. The diagnostic performance of the LI-RADS category M (LR-M) algorithms of SonoVue® and Sonazoid® was comparable.

Conclusions

The Sonazoid® modified LR-5 algorithm had a higher diagnostic sensitivity, lower specificity, and higher AUC than SonoVue® LR-5.

Effects of ferritin heavy chain on oxidative stress, cell proliferation and apoptosis in geese follicular granulosa cells

1. The ferritin heavy chain (FHC) has a vital impact on follicular development in geese, due to its ability to regulate apoptosis of granulosa cells (GCs) and follicular atresia. However, its specific regulatory mechanisms remain unclear. The present study characterised how FHC regulates oxidative stress, cell proliferation and apoptosis in goose GCs by interfering with and overexpressing the FHC gene.2. After 72 h of interference with FHC expression, the activity of GCs decreased remarkably (p < 0.05), reactive oxygen species (ROS) levels and the expression levels of antioxidant enzyme genes catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) increased significantly (p < 0.05). The overexpression of FHC for 72 h was found to significantly reduce the expression of CAT and SOD genes (p < 0.05).3. Interfering with FHC expression revealed that the expression levels of the cell proliferation gene Aurora kinase A (AURORA-A) were significantly decreased (p < 0.05), while the expression levels of the apoptosis genes B-cell lymphoma-2 (BCL-2) and cysteine aspartate-specific protease 8 (CASPASE 8) increased (p < 0.05). Further research has shown that, when interfering with FHC expression for 72 h, apoptosis rate increased by 1.19-fold (p < 0.05), but the current data showed a lower apoptosis rate after FHC overexpression by 59.41%, 63.39%, and 52.31% at three different treatment times (p < 0.05).4. In conclusion, FHC improved the antioxidant capacity of GCs, promotes GCs proliferation, and inhibits GCs apoptosis of ovarian follicles in Sichuan white geese.

Contrast-enhanced ultrasound reveals free-floating thrombus in carotid artery - The cause of stroke is surprisingly plaque rupture

BACKGROUND

Acute stroke poses a serious threat to people's health. The occurrence of a thrombus following the rupture of vulnerable plaques in the carotid artery is a significant contributor to the development of stroke. In previous case reports, it has been challenging to visualize tiny ulcerations within carotid artery plaques using computed tomography angiography (CTA) and digital subtraction angiography (DSA), even when the rupture of the plaque leads to the formation of a free-floating thrombus (FFT). However, in this particular case, contrast-enhanced ultrasound (CEUS) was able to overcome this limitation and provide a more precise assessment, confirming that the FFT formation was indeed a result of plaque rupture rather than any other potential causes. Cases that utilize CEUS to visualize the formation of ulcers and FFT resulting from plaque rupture are even more rare. As such, we present this case to shed light on this infrequent phenomenon.

CASE SUMMARY

In this case study, we present a 65-year-old male patient who was admitted to the hospital due to headache and abnormal mental behavior for one day. During the routine cervical artery ultrasound examination upon admission, we detected the presence of plaque in the right internal carotid artery of the patient, resulting in luminal stenosis. Additionally, we observed suspected hypoechoic material at the distal end of the plaque. After undergoing CEUS examination, it was definitively determined that an ulcer had formed and a FFT had developed due to the rupture of carotid artery plaque. Subsequent CTA and DSA examinations further confirmed the presence of the FFT. The magnetic resonance imaging (MRI) reveals an acute lacunar infarction in the head of the right caput nuclei caudate, which strengthens the potential link between the patient's neurological and psychiatric symptoms observed during admission. The patient received prompt antiplatelet therapy and underwent cervical artery stenting surgery with the assistance of a distal embolic protection device. Following the procedure, the patient was discharged on the fourth day and experienced a complete recovery.

CONCLUSION

CEUS is a valuable tool for visualizing FFT resulting from the rupture of vulnerable plaques in the carotid artery.

Technical note: High-efficient and wireless transcranial ultrasound excitation based on electromagnetic acoustic transducer

BACKGROUND

The generation of transcranial ultrasound is usually based on the piezoelectric effect, so it is necessary to attach transducers around the skull. However, the skull will cause serious attenuation and scattering of ultrasound, which makes it particularly difficult for transcranial ultrasound imaging and modulation.

PURPOSE

In transcranial ultrasound imaging, there is significant attenuation and scattering of ultrasound waves by the skull bone. To mitigate this influence and enable precise imaging and high-efficient transcranial ultrasound for specific patients (such as stroke patients who already require craniotomy as part of their surgical care), this paper proposes to use EMAT to excite metal plates placed inside the skull based on the excellent penetration characteristics of EM waves into the skull, generating ultrasound signals, which can completely avoid the influence of skull on ultrasound transmission.

METHODS

Based on an efficient wireless transcranial ultrasound experimental platform, we first verified that the skull would not affect the propagation of electromagnetic waves generated by EMAT. In addition, the distribution of the transcranial sound field generated by EMAT was measured.

RESULTS

EMAT can generate 1.0 MHz ultrasound by wireless excitation of a 0.1 mm thick copper plate through an adult skull with a thickness of ∼1 cm, and the frequency and amplitude of the generated ultrasound are not affected by the skull. The results indicated that the electromagnetic waves successfully penetrated the skull, with a recorded strength of approximately 2 mV. We also found that the ultrasound signals generated by the EMAT probe through the skull remained unaffected, measuring around 2 mV. In addition, the measurement of the transcranial sound field distribution (80*50 mm2 ) generated by EMAT shows that compared with the traditional extracranial ultrasound generation method, the sound field distribution generated by the wireless excitation of the intracranial copper plate based on EAMT is no longer affected by the uneven and irregular skull.

CONCLUSION

Our experiments involved validating the penetration capabilities of electromagnetic waves utilizing the EMAT probe through a 7 (5+2) mm thick organic glass plate and a real human skull ranging from 8 to 15 mm in thickness. The efficient and wireless transcranial ultrasound excitation proposed in this paper may be possible for transcranial ultrasound imaging and therapy.

The current role of radiofrequency ablation in the treatment of intrahepatic recurrent hepatocellular carcinoma

The incidence of recurrent hepatocellular carcinoma (HCC) after initial curative treatments is relatively high. However, there is still the lack of standard management of recurrent HCC. Among several treatment modalities for primary HCC, radiofrequency ablation (RFA) seems to be more widely used for intrahepatic recurrent lesions. Therefore, we provide a comprehensive review of the current and novel application of RFA for recurrent HCC in all stages after curative treatment of primary HCC.

Efficient scheduling and attendance system for the ultrasound department under demand uncertainty during COVID-19

Scheduling and attendance management present huge challenges for hospitals, and the importance of both has become more critical as resource limitations and overwhelmingly uncertain demand are becoming more evident, especially during COVID-19. Important variables and factors need to be considered. When managers address this problem, they either use a manual approach or invest in expensive commercial tools. We propose a simple and flexible system that requires no extra investment. This system was developed using Ding Talk, Microsoft Excel and Visual C#. Ding Talk was used to collect vacation applications and clock information. A VBA-based Microsoft Excel program was developed to schedule shifts. A Windows Forms Application based on Visual C# was developed to complete the workload and attendance statistics. We focused on the design and implementation of the module of schedule generation and attendance management. Using the practical data of the Ultrasound Department, we compared the time spent on scheduling and attendance before and after the system was established. The results demonstrate that the system is feasible and efficient. Its high flexibility enables managers to quickly modify the schedule and attendance statistics to achieve dynamic management when dealing with inevitable demand changes during COVID-19.

Diagnosis of liver fibrosis and liver function reserve through non-invasive multispectral photoacoustic imaging

Liver function reserve (LFR) is the sum of remnant functional hepatic cells after liver injury. In the pathologic process of liver fibrosis (LF), LFR is impaired. LFR assessment can help determine the safe scope of liver resection or drug regimen and predict prognosis of patients with liver disease. Here, we used a photoacoustic imaging (PAI) system to assess LF and LFR in rabbit models. We performed PAI, ultrasound elastography and biopsy for 21 rabbits developing none (n = 6) and LF (n = 15). In vivo indocyanine green (ICG) measurements by PAI showed that LF group presented a significantly attenuated ICG clearance compared to control group, indicating LFR impairment of LF. Another finding was a significantly higher collagen photoacoustic signal intensity value was observed in LF both in vivo and in vitro. Our findings demonstrated that PAI was potentially effective to evaluate LFR and collagen accumulation of LF.

Compared with CT/MRI LI-RADS, whether CEUS LI-RADS is worth popularizing in diagnosis of hepatocellular carcinoma?-a direct head-to-head meta-analysis

Background

Until now, there has been no systematic review or meta-analysis of direct head-to-head studies that compare two liver imaging reporting and data system (LI-RADS) algorithms, contrast-enhanced ultrasound (CEUS) LI-RADS and contrast-enhanced computed tomography/magnetic resonance imaging (CT/MRI) LI-RADS, for the diagnostic efficacy of hepatocellular carcinoma. The purpose of this study was to identify and head-to-head compare the diagnostic performance of both LI-RADS algorithms for hepatocellular carcinoma.

Methods

We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases from the inception of each database to April 26, 2022, to find the comparative study of both LI-RADS algorithms for hepatocellular carcinoma at risk of patients who underwent both LI-RADS algorithms. Eligibility criteria included only studies published in English, full reports published, both retrospective and prospective studies. Liver histology or imaging follow-up results served as the reference standard. We analyzed the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristic curve to determine summary estimates. The Quality Assessment of Diagnostic Accuracy Studies was utilized to assess the methodological quality.

Results

In 5 included studies (831 patients, 877 lesions), the pooled sensitivity and pooled specificity of CEUS LR-5 were 0.79, 0.81, and 0.78, 0.79 in CT/MRI LR-5, respectively. The pooled sensitivity and pooled specificity of CEUS LR-4/5 were 0.86, 0.70, and 0.93, 0.59 in CT/MRI LR-4/5, respectively. There was no obvious difference between the two LI-RADS algorithms for hepatocellular carcinoma, and there was no significant statistical difference between two LR-M algorithms for non-hepatocellular carcinoma malignancies.

Conclusions

The results of our analysis demonstrated that CEUS LI-RADS has satisfactory diagnostic performance similar to that of CT/MRI LI-RADS, which provides a theoretical basis for the popularization of CEUS LI-RADS for diagnosing HCC. This work was supported by Sichuan Science and Technology Program (No. 2020YFS0211). We registered this study on the international prospective register of systematic reviews (PROSPERO, CRD42022328107) before the search step.

ICG clearance test based on photoacoustic imaging for assessment of human liver function reserve: An initial clinical study

Liver function reserve (LFR) plays an extensive and important role in patients with liver disease. Indocyanine green (ICG) clearance test is the standard diagnostic approach for LFR evaluation which was performed by spectrophotometry or pulse dye densitometry (PDD). Spectrophotometry is the gold standard, it's invasive and not real-time. PDD is non-invasive, but accuracy of PDD is controversial. Taken spectrophotometry as the reference standard, this study investigated the accuracy of photoacoustic imaging (PAI) method for LFR assessment and compared to PDD in healthy volunteers. The results demonstrated a strong correlation between PAI method and spectrophotometry (r = 0.9649, p < 0.0001). No significant difference was shown in ICG clearance between PAI and spectrophotometry method (rate constant k1 vs. k2, 0.001158 +-0.00042 vs. 0.001491 +- 0.00045, p = 0.0727; half-life t1 vs. t2, 601.2 s vs. 474.4 s, p = 0.1450). These results indicated that PAI may be valuable as a noninvasive, accurate diagnostic tool for LFR assessment in human.

LI-RADS LR-5 on contrast-enhanced ultrasonography has satisfactory diagnostic specificity for hepatocellular carcinoma: a systematic review and meta-analysis

Background

The Liver Imaging Reporting and Data System (LI-RADS) for contrast-enhanced ultrasonography (CEUS) was invented to define suspected liver nodules based on their imaging characteristics. Among the categories of nodules of LI-RADS for CEUS, LR-5 is generally considered to be definitely malignant; however, the exact diagnostic performance of this liver nodule category has varied between different studies. Therefore, we performed this systematic review and meta-analysis to calculate the pooled diagnostic sensitivity, specificity based on important data extracted from some influential clinical studies.

Methods

A preliminary search of national and international databases, including PubMed/Ovid Medline, Embase, Cochrane Library, Web of Science, and Wan Fang Data, for relevant studies on CEUS LI-RADS LR-5 published between January 2017 and June 2021 was conducted. A literature screening and selection process was undertaken to evaluate the relevance of the articles, and studies deemed eligible for inclusion in the review were subsequently identified. The updated Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was applied as the main method to assess the risk of bias and applicability of the studies. A meta-analysis of the diagnostic sensitivity and specificity of CEUS LI-RADS LR-5 was performed using the free software, Meta-DiSc 1.4 (Ramóny Cajal Hospital, Madrid, Spain). The area under curve (AUC) was calculated to help determine the diagnostic efficiency. A meta-regression analysis was also performed to identify factors that could have contributed to heterogeneity between the studies.

Results

Twelve studies with 20 observations focused on investigating the relative diagnostic performance of the CEUS LI-RADS LR-5 category for hepatocellular carcinoma (HCC) detection were finally recruited into the systematic review and meta-analysis. The pooled diagnostic sensitivity was 0.71 [95% confidence interval (CI): 0.69-0.72], with heterogeneity (I²) of 88.4%, and the pooled specificity was 0.93 (95% CI: 0.92-0.95), with an I² of 71.2%. Study heterogeneity was observed and statistically correlated with the number of centers and the reference standard.

Conclusions

The CEUS LI-RADS LR-5 category has satisfactory diagnostic efficacy for HCC, as evidenced by an acceptable diagnostic sensitivity of 0.71 and a good diagnostic specificity of 0.93.

International curriculum for undergraduate sonographer education in China during the COVID-19 era: International remote teaching mode vs. domestic on-site teaching mode

Background

Sichuan University West China Medical School was the first institution in China to develop an undergraduate sonographer education program in 2016. This program was certificated by American Registry for Diagnostic Medical Sonography (ARDMS) and students are qualified for the ARDMS credential verification test. In this 4-year program, the international curriculum of ultrasound physics and hemodynamics was set for students in the third year since 2018. This study is aimed to compare the teaching effect of international remote teaching mode and domestic on-site teaching mode of this international curriculum before and during the COVID-19 pandemic.

Methods

All undergraduate sonographer students after completing ultrasound physics and hemodynamics in the academic years 2018-2019 (30 students; before the COVID-19 pandemic) and 2020-2021 (47 students; during the COVID-19 pandemic) were included in the study. The scores of 77 students were analyzed for their curriculum. Independent samples t-test or Mann-Whitney test was employed to compare students' scores before and during the COVID-19 pandemic. The Chi-square test was used to compare students' feedback about this curriculum through an online self-administered questionnaire. A p < 0.05 was considered statistically significant.

Results

Total scores were comprised of four parts: in-class tests, homework, mid-term, and final exam scores. The mean in-class test score for domestic on-site teaching mode during the COVID-19 pandemic was significantly higher than that for international remote teaching mode before the COVID-19 pandemic. However, there was no observed a statistically significant difference in homework, mid-term, final exam, and total scores between the two types of teaching modes. For questionnaire feedback, no significant difference was observed between the two groups regarding the satisfaction toward teachers, class atmosphere, teaching mode, curriculum content, exam difficulty, scores, and knowledge students gained. For the overall evaluation of the curriculum, 73.3% (22/30) of students were very satisfied before the COVID-19 pandemic, while 44.7% (21/47) of students felt very satisfied during the COVID-19 pandemic (p = 0.02).

Conclusion

The general teaching effect of domestic on-site teaching mode during the COVID-19 pandemic was comparable to that of international remote teaching mode before the COVID-19 pandemic, and domestic on-site teaching mode may provide a better in-class teaching effect.

Improved Ultrasound Attenuation Estimation with Non-uniform Structure Detection and Removal

Accurate detection of liver steatosis is important for liver disease management. Ultrasound attenuation coefficient estimation (ACE) has great potential in quantifying liver fat content. The ACE methods commonly assume uniform tissue characteristics. However, in vivo tissues typically contain non-uniform structures, which may bias the attenuation estimation and lead to large standard deviations. Here we propose a series of non-uniform structure detection and removal (NSDR) methods to reduce the impact from non-uniform structures during ACE analysis. The effectiveness of NSDR was validated through phantom and in vivo studies. In a pilot clinical study, ACE with NSDR provided more robust in vivo performance as compared with ACE without NSDR, indicating its potential for in vivo applications.

Application of Ultrasound Elastography in Assessing Portal Hypertension

Portal hypertension is a common manifestation in late-to-end-stage liver diseases and can cause severe complications such as ascites, hepatic encephalopathy, etc. However, an early diagnosis of portal hypertension is often difficult as it can be asymptomatic. Though the gold standard to diagnose portal hypertension is hepatic vein catheterization, ultrasound elastography is regarded as a noninvasive alternative that can be used to accurately predict portal hypertension and a few further complications such as gastro-esophageal varices. Since ultrasound elastography is available in most medical centers, and is cheaper and noninvasive, studying its function in predicting portal hypertension is of paramount importance. Therefore, this review generalized the results of recently published articles in order to establish the indicators that were related to diagnostic and prediction efficiency. Our study found that various technologies of ultrasound elastography could be used to predict portal hypertension with satisfactory diagnostic sensitivity, specificity, accuracy, and AUC. Meanwhile, we also recognized similar diagnostic efficiency of ultrasound elastography in gastro-esophageal varices.

Contrast-enhanced ultrasound of pancreatic melanoma: A case report and literature review

Melanoma is a malignant tumor that originates from melanocytes, most of which are of cutaneous origin. Most melanomas identified in the pancreas are metastatic, and primary pancreatic melanoma is extremely rare and has rarely been discussed. The correct preoperative diagnosis of pancreatic metastatic melanoma, especially primary melanoma, is challenging. Herein, we report a 43-year-old man who presented to our hospital due to unexplained left abdominal distension and pain. Abdominal ultrasound examination demonstrated multiple space-occupying lesions of the pancreas, and hypoechoic masses partially filled the splenic vein behind the pancreatic body. In the contrast-enhanced ultrasound (CEUS), all of these lesions showed iso-enhancement to slight hypo-enhancement in the arterial phase and hypo-enhancement in the venous phase. Masses in the splenic vein also showed hypo-enhancement. Imaging features suggested that the pancreatic lesions were malignant tumors. The tumor markers carcinoembryonic antigen, carbohydrate antigen 125 and carbohydrate antigen 19-9 were within normal limits. Based on clinical symptoms, imaging findings and incidence of pancreatic tumors, the patient’s clinical diagnosis was pancreatic carcinoma. Surgery was performed for the patient, while postoperative pathology confirmed malignant melanoma of the pancreas. Therefore, it is significant to identify the clinical and imaging manifestations of pancreatic melanoma in order to better manage the disease. Herein, we reported this case and reviewed the literature from 2000 to 2021 on the clinical and imaging features of 26 patients with pancreatic melanoma. It may improve clinicians’ awareness of the clinical and imaging performance of pancreatic melanoma, resulting in improved diagnosis, differential diagnosis, treatment, and outcomes.

Shear wave elastography using sound touch elastography and supersonic shear imaging for liver measurements: a comparative study

BACKGROUND

Measurements of liver stiffness obtained with 2-dimensional shear wave elastography (2D-SWE) have been widely used to clinically assess liver fibrosis. However, differences between different 2D-SWE systems can lead to confusion when interpreting measurements. This study investigated the variability between a recently released sound touch elastography (STE) system and a supersonic shear imaging (SSI) system and assessed the degree of intersystem discrepancy using the different liver stiffness value (LSV) thresholds recommended by the Society of Radiologists in Ultrasound (SRU) for assessing liver fibrosis.

METHODS

A total of 4,152 patients who had undergone STE and SSI on the same day were enrolled in this retrospective study. First, intrasystem agreement for STE and SSI was assessed. Then, intraclass correlation coefficients (ICCs) and the Bland-Altman method were used to assess intersystem variability for all cases, classified according to the thresholds recommended by the SRU. The effects of age, gender, and body-mass index (BMI) were evaluated using multivariate linear regression analysis and attributive intervals were computed for STE and SSI at each of the different thresholds.

RESULTS

The ICCs for STE and SSI intrasystem agreement were 0.94 [95% confidence interval (CI): 0.937-0.943; P<0.001] and 0.984 (95% CI: 0.984-0.985; P<0.001), respectively. The 95% limit of agreement (LOA) for all cases ranged from -6.96 to 7.44 kPa. The 95% LOA increased as the threshold values rose, and intersystem variability was obvious, even at the smallest threshold (the 95% LOA at values ≤5 kPa was -0.85 to 2.08 kPa, while that at values >17 kPa was -20.81 to 14.71 kPa). The adjusted R2 for age, gender, and BMI was only 0.018 (all P value <0.05).

CONCLUSIONS

There was clear variability between STE and SSI, in contrast with some previous studies with small sample sizes, and consistent with others. Intersystem variability increased with the elevation of the LSV thresholds recommended by the SRU. Gender and BMI had little effect on intersystem variability. Future research could compare STE and SSI in different liver diseases, assessing the feasibility of the SRU-recommended thresholds in proven pathologies and evaluating the test-retest repeatability.

Quantitative assessment of renal damage in rhesus monkeys with diabetic nephropathy using contrast-enhanced ultrasound

Background

Diabetic nephropathy (DN) is a common chronic microvascular complication of diabetes. Noninvasive diagnosis of DN is difficult. Contrast-enhanced ultrasound (CEUS), as a functional imaging method, provides noninvasive real-time images and quantitative assessment of renal microvascular perfusion. This study investigated the efficacy of CEUS in discriminating between DN and normal kidneys in rhesus monkeys.

Methods

A total of 12 male rhesus monkeys (DN model group, n=6; normal control group, n=6) were included in this study. The following parameters were evaluated: (I) blood biochemistry; (II) CEUS; and (III) ultrasound-guided renal biopsy.

Results

Pathological and biochemical results showed that all subjects in the lesion group had serious renal damage. There were significant differences in the CEUS parameters, including the area under the curve, the time from peak to one half, and peak intensity between the lesion group and the normal group. The time to peak was slightly delayed in the lesion group. There was no significant difference in the rise time between the two groups.

Conclusions

Although the precise CEUS parameters that may best predict renal damage still require systematic evaluation, the results of these animal studies suggest that CEUS may be used as a supplemental tool in diagnosing renal damage in rhesus monkeys with DN. We hope these findings can provide insights for the application of CEUS in DN.

Conventional Ultrasound and Contrast-Enhanced Ultrasound in Hepatic Epithelioid Hemangioendothelioma: Retrospective Evaluation in 20 Cases

OBJECTIVES

This study aimed to analyze the patterns of conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) in 20 patients with diagnosis of hepatic epithelioid hemangioendothelioma (HEHE).

METHODS

Twenty patients (12 females and 8 males) with mean age of 43.6 ± 13.6 years were included in this study from January 2012 to May 2020. CUS, CEUS, computed tomography (CT) and magnetic resonance imaging (MRI) features of the twenty patients with histologically proven HEHE were retrospectively reviewed by two radiologists. The clinical manifestations and the pathological findings of all patients with HEHE are described.

RESULTS

There were 3 types of HEHE in imaging, including single nodular (8/20, 40%), multifocal nodular (10/20, 50%), and diffuse type (2/20, 10%). The mean size of lesions was 4.2 ± 2.6 cm. B-mode ultrasound of HEHE showed hypoechoic (15/20, 75%), heterogeneous echogenicity (4/20, 20%), or hyperechoic (1/20, 5%) lesions with regular shape (18/20, 90%) near the liver capsule (17/20, 85%), and occasionally with a halo (4/20, 20%) and calcifications (3/20, 15%). Eight out of the 20 patients also had CEUS. On CEUS, HEHE demonstrated peripheral rim-like (5/8, 62.5%), heterogeneous (2/8, 25%), or homogeneous (1/8, 12.5%) hyperenhancement in the arterial phase. All patients (8/8, 100%) showed hypoenhancement in the portal and late phase. CEUS detected more lesions than CUS in 3 patients (3/8, 37.5%). In addition, central irregular unenhanced zones were observed in 6 patients (6/8, 75%). On contrast-enhanced CT or MRI, most cases presented with capsule retraction sign and lollipop sign.

CONCLUSIONS

HEHE demonstrated specific findings on ultrasound, which includes multifocal hypoechoic lesions in a subcapsular distribution with typical enhancement characteristics of malignant hepatic tumors.

Contrast-Enhanced Ultrasound Findings of Hepatocellular Carcinoma With Neuroendocrine Carcinoma: A Case Report

Hepatocellular carcinoma (HCC) with the concurrent occurrence of primary hepatic neuroendocrine carcinoma (NEC) of the liver is extremely rare. Preoperative diagnosis of HCC combined with NEC is very difficult. Here, we presented a case report of HCC combined with NEC. A 33-year-old male was admitted to our hospital due to focal liver lesion. To further the diagnosis, he received laboratory tests, conventional ultrasound, contrast-enhanced ultrasound (CEUS), and magnetic resonance imaging (MRI). Grayscale ultrasound showed a hypoechoic nodule with peripheral hypoechoic halo and central small patches of anechoic area in the hepatic segment VI, and the liver background was cirrhosis. In the CEUS, the solid component of the nodule was rapidly homogeneous hyper-enhancement in the arterial phase. Then, the enhancement of the nodule was washed out slowly and gradually; the nodule presented heterogeneously mild enhancement in the portal phase, and slight hypo-enhancement was showed in the late phase. The hypo-enhanced area was mainly located in the surrounding space. Meanwhile, there was a small piece of non-enhanced area within the lesion center in the whole three-phase imaging. MRI showed a lobular contoured mass in segment VI. The patient underwent middle liver resection, splenectomy, and cholecystectomy. The pathological diagnosis was a HCC with NEC. At the time of the preparation of this manuscript, the patient has been alive without recurrence or distant metastases for 6 months since the surgery. We mainly focus on the ultrasound imaging characteristics, especially its enhancement manifestations on CEUS. In this report, since this article is a case report, which is based on the clinical information of the patient and does not involve the patient's privacy, informed consent is not necessary. In addition, the patient agreed to publish the case. To the best of our knowledge, this report is the first to describe the CEUS patterns of the HCC combined with NEC. Herein, we report a case that provides novel insights that will improve clinicians' awareness of the clinical and ultrasound manifestations of this mixed tumor, resulting in improved diagnosis, treatment, and outcomes.

Quantitative Shear Wave Speed Assessment for Muscles with the Diagnosis of Taut Bands and/or Myofascial Trigger Points Using Probe Oscillation Shear Wave Elastography: A Pilot Study

OBJECTIVE

To use probe oscillation shear wave elastography (PROSE) with two vibration sources to generate two shear waves in the imaging plane to quantitatively assess the shear wave speeds (SWSs) of muscles with and without the diagnosis of taut bands (TB) and/or myofascial trigger points (MTrPs).

METHODS

Thirty-three patients were scanned with the PROSE technique. Shear waves were generated through continuous vibration of the ultrasound probe, while the shear wave motions were detected using the same probe. SWSs for the sides with and without TBs and/or MTrPs were computed and compared. The pressure pain thresholds (PPTs) were measured as an indicator of maximum pain tolerance of patients. The statistical differences between the SWSs with and without TBs and/or MTrPs with different PPT values were analyzed using the nonparametric Wilcoxon rank-sum test.

RESULTS

The mean SWSs for the sides with TBs and/or MTrPs are faster than that of the contralateral side without TBs and/or MTrPs. A significant difference was observed between mean SWSs with and without TBs and/or MTrPs without any information of PPT, with rank-sum test P <  .005. Additionally, with the information of PPT, a significant difference was observed between mean SWSs for the sides with and without TBs and/or MTrPs, for PPT values between 0 and 50 N/cm² (P <  .005), but for PPT values between 50 and 90 N/cm² , it was difficult to differentiate mean SWSs with and without TBs and/or MTrPs.

CONCLUSION

Our preliminary results show that SWSs measured from patients had a significant difference between the mean SWSs with and without TBs and/or MTrPs.

Comparison between preoperative two-dimensional shear wave elastography and indocyanine green clearance test for prediction of post-hepatectomy liver failure

Background

Post-hepatectomy liver failure (PHLF) is one of the most serious complications and major causes of liver resection mortality. The purpose of this study is to investigate and compare the performance of preoperative two-dimensional shear wave elastography (2D-SWE) and the indocyanine green (ICG) clearance test for the prediction of PHLF.

Methods

A total of 172 consecutive patients who were undergoing major liver resection were prospectively identified. Patients were evaluated by preoperative 2D-SWE and ICG clearance test. According to the International Study Group of Liver Surgery (ISGLS) recommendations, No PHLF, PHLF A, PHLF B, and PHLF C group classifications were defined. The differences in liver stiffness value (LSV) and ICG retention rate at 15 minutes (ICGR15) among the different PHLF classifications were investigated. The performance of LSV and ICGR15 for diagnosing different classifications of PHLF was compared.

Results

PHLF occurred in 43 (25.0%) patients, and 24 (14.0%) patients were grade A, 14 (8.1%) were grade B, and 5 (2.9%) were grade C. Both LSV and ICGR15 of the PHLF C group were significantly higher than those of the No PHLF group (P=0.025, P=0.001, respectively). According to univariate and multivariate logistic regression analysis, LSV and ICGR15 were significantly related to PHLF (P=0.051, P=0.084, respectively). For diagnosis of ≥ PHLF A, ≥ PHLF B, and ≥ PHLF C, the areas under the receiver operating characteristic curve (AUCs) for 2D-SWE were 0.624 [95% confidence interval (CI): 0.536-0.712, P=0.015], 0.699 (95% CI: 0.576-0.821, P=0.005), and 0.831 (95% CI: 0.737-0.925, P=0.01), respectively. The AUCs of the ICG clearance test were 0.631 (95% CI: 0.542-0.721, P=0.01), 0.570 (95% CI: 0.436-0.704, P=0.32), and 0.717 (95% CI: 0.515-0.920, P=0.098), respectively. The AUC of LSV for the diagnosis of ≥ PHLF A was comparable to that of ICGR15 (P=0.17). The AUCs of LSV were significantly higher than those of ICGR15 for the diagnosis of ≥ PHLF B (P=0.002) and C (P=0.038).

Conclusions

2D-SWE demonstrates the potential to aid in the prediction of the severity of PHLF. Our findings also suggest that the performance of 2D-SWE is better than the ICG clearance test.

Can Risk Stratification Based on Ultrasound Elastography of Background Liver Assist CEUS LI-RADS in the Diagnosis of HCC?

Objective

To explore whether risk stratification based on ultrasound elastography of liver background assists contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) in diagnosing HCC.

Materials and Methods

In total, 304 patients with focal liver lesions (FLLs) confirmed by pathology underwent CEUS and ultrasound elastography were included in this retrospective study. Patients with chronic hepatitis B (CHB, n=193) and non-CHB (n=111) were stratified by four liver stiffness measurement (LSM) thresholds. A LI-RADS category was assigned to FLLs using CEUS LI-RADS v2017. The diagnostic performance was assessed with the AUC, sensitivity, specificity, PPV, and NPV.

Results

The mean background liver stiffness of HCC patients with CHB, HCC patients without CHB and non-HCC patients without CHB were 9.72 kPa, 8.23 kPa and 4.97 kPa, respectively. The AUC, sensitivity, specificity and PPV of CEUS LI-RADS for HCC in CHB patients with LSM ≥ 5.8 kPa, ≥ 6.8 kPa, ≥ 9.1 kPa, and ≥ 10.3 kPa were high, with corresponding values of 0.745 to 0.880, 94.2% to 95.3%, 81.3% to 85.7%, and 98.1% to 98.8%, respectively. Higher AUC and specificity for HCC was observed in non-CHB patients with LSM ≥ 9.1 kPa and ≥ 10.3 kPa compared to non-CHB patients with LSM ≥ 5.8 kPa and ≥ 6.8 kPa, with corresponding values of0.964/1.000 vs 0.590/0.580, and 100%/100% vs 60%/70%, respectively.

Conclusion

CEUS LI-RADS has a good diagnostic performance in CHB patients regardless of the background liver stiffness. Furthermore, CEUS LI-RADS can be applied for non-CHB patients with a LSM ≥ 9.1 kPa.

Shear wave-based sound touch elastography in liver fibrosis assessment for patients with autoimmune liver diseases

Background

Shear wave-based ultrasonic elastography (USE) has been widely used for the assessment of liver fibrosis in patients with chronic liver diseases (CLD). However, diagnostic criteria and accuracy vary between different etiologies and specific elastography techniques. We aimed to evaluate the tissue stiffness measured by shear wave-based sound touch elastography (STE) in staging liver fibrosis in patients with autoimmune liver diseases (AILD).

Methods

One hundred and two AILD patients who had undergone STE liver stiffness measurements (LSMs) by using a Resona 7 ultrasound system were retrospectively studied. With the Scheuer liver fibrosis staging system as the reference, we investigated the diagnostic performance and cutoff values of STE measured liver stiffness in staging liver fibrosis through receiver operating characteristic (ROC) curve analysis. Moreover, comparisons of areas under the curve (AUCs) were made between LSMs and calculated biomarker scores, including the aspartate aminotransferase (AST)-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) index.

Results

Median LSMs increased with the advancing fibrosis stages with values of 6.89 kPa (1.51 m/s), 8.00 kPa (1.63 m/s), 9.60 kPa (1.79 m/s), 11.37 kPa (1.95 m/s) and 14.50 kPa (2.20 m/s), from stage 0 to stage 4 respectively. The cutoff values of STE for identifying significant fibrosis (≥ stage 2), severe fibrosis (≥ stage 3) and cirrhosis (stage 4) were 9.07 kPa (1.74 m/s), 9.97 kPa (1.82 m/s) and 10.48 kPa (1.87 m/s), respectively, with corresponding sensitivity of 79.1%, 93.3%, and 100%; specificity of 80.0%, 70.8% and 71.8%. The AUCs of LSMs in identifying fibrosis ≥ stage 2, ≥ stage 3 and stage 4 (0.82, 0.87, and 0.91, respectively) were significantly higher than that of APRI (0.67, 0.64, and 0.72, respectively) and FIB-4 (0.70, 0.68, and 0.75, respectively) (all P<0.05).

Conclusions

LSM obtained by STE exhibited its good capability to evaluate liver fibrosis stages in patients with AILD. As a noninvasive modality for liver fibrosis staging, STE is superior to APRI and FIB-4 biomarker scores.

Down-regulation of long non-coding RNA DUXAP8 suppresses proliferation, metastasis and EMT by modulating miR-498 through TRIM44-mediated AKT/mTOR pathway in non-small-cell lung cancer

OBJECTIVE

The long non-coding RNA double homeobox A pseudogene 8 (DUXAP8) was reported to be involved in the initiation and development of multiple cancers. However, the detailed biological role of DUXAP8 in non-small-cell lung cancer (NSCLC) remains unclear. Herein, we aimed to explore the biological function and molecular mechanism of DUXAP8 in NSCLC.

PATIENTS AND METHODS

The levels of DUXAP8, microRNA-498 (miR-498) and tripartite motif-44 (TRIM44) were detected by Quantitative Real-time polymerase chain reaction (qRT-PCR). The cell proliferation, migration and invasion were detected by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and transwell assays. Protein expression levels were detected by Western blot. The target relationships among DUXAP8, miR-498 and TRIM44 were predicted by starBase2.0 and confirmed using luciferase reporter and RNA pull-down assays. To detect the role of DUXAP8 in vivo, tumor xenografts were created.

RESULTS

DUXAP8 and TRIM44 were upregulated in NSCLC tissues and cell lines, while miR-498 was downregulated. Functionally, knockdown of DUXAP8 could repress proliferation, migration, invasion, Epithelial-Mesenchymal Transition (EMT) and phosphorylation of AKT/mTOR in NSCLC cells. This inhibition could be restored by inhibiting miR-498 or overexpressing TRIM44. Furthermore, we also observed a positive correlation between DUXAP8 and TRIM44 expression, while the expressions of miR-498 and DUXAP8, as well as miR-498 and TRIM44, were negatively correlated in NSCLC tissues. Importantly, DUXAP8 could regulate the expression of TRIM44 via miR-498. Moreover, knockdown of DUXAP8 notably decreased the xenograft tumor volume, weight and number of metastatic nodules in vivo.

CONCLUSIONS

Our results identified that LncRNA DUXAP8 could regulate cell proliferation, metastasis and EMT in NSCLC cells by inhibiting miR-498 through the activation of TRIM44-mediated AKT/mTOR pathway.

True Aneurysm of the Breast After Vacuum-assisted Removal of Benign Masses: A Case Report

Rationale

The most common complications of vacuum-assisted removal (VAR) for benign breast masses are hematoma, infection, and occasionally pseudoaneurysms. To the best of our knowledge, this is the first report of a true aneurysm following VAR for breast fibroadenomas.

Case Presentation

A 50-year-old woman underwent VAR of bilateral benign breast masses under ultrasonic guidance. Routine breast ultrasound examination was performed 3 months later, and no discomfort was observed during follow-up.

Diagnoses and Interventions

Physical examination revealed a slightly palpable, arterial-like pulsation in the lateral part of the right breast. The two-dimensional ultrasound showed that there was a well-defined anechoic nodule in the right breast at the 9 o’clock position 3 cm from the nipple, measuring 6 mm × 4 mm. Color Doppler sonography demonstrated that it was a localized dilated intramammary arteriole within the colorful flow. Spectral Doppler illustrated a high-velocity turbulent arterial flow component inside. Based on these findings, the patient was diagnosed with an iatrogenic true aneurysm of the breast. Given her overall good condition, conservative treatment with regular imaging surveillance was adopted.

Outcomes

Up to now, the patient remains asymptomatic, and the size of the aneurysm has not changed.

Lessons

With the increasing use of interventional diagnosis and treatment techniques, iatrogenic vascular complications are likely to occur more frequently. Careful duplex ultrasound examination prior to or following the procedure is strongly recommended. In the absence of risk factors, we recommend a conservative approach to small, stable aneurysms.

Three-dimensional shear wave elastography on conventional ultrasound scanners with external vibration

Two-dimensional (2D) ultrasound shear wave elastography (SWE) has been widely used for soft tissue properties assessment. Given that shear waves propagate in three dimensions (3D), extending SWE from 2D to 3D is important for comprehensive and accurate stiffness measurement. However, implementation of 3D SWE on a conventional ultrasound scanner is challenging due to the low volume rate (tens of Hertz) associated with limited parallel receive capability of the scanner's hardware beamformer. Therefore, we developed an external mechanical vibration-based 3D SWE technique allowing robust 3D shear wave tracking and speed reconstruction for conventional scanners. The aliased shear wave signal detected with a sub-Nyquist sampling frequency was corrected by leveraging the cyclic nature of the sinusoidal shear wave generated by the external vibrator. Shear wave signals from different sub-volumes were aligned in temporal direction to correct time delays from sequential pulse-echo events, followed by 3D speed reconstruction using a 3D local frequency estimation algorithm. The technique was validated on liver fibrosis phantoms with different stiffness, showing good correlation (r = 0.99, p < 0.001) with values measured from a state-of-the-art SWE system (GE LOGIQ E9). The phantoms with different stiffnesses can be well-differentiated regardless of the external vibrator position, indicating the feasibility of the 3D SWE with regard to different shear wave propagation scenarios. Finally, shear wave speed calculated by the 3D method correlated well with magnetic resonance elastography performed on human liver (r = 0.93, p = 0.02), demonstrating the in vivo feasibility. The proposed technique relies on low volume rate imaging and can be implemented on the widely available clinical ultrasound scanners, facilitating its clinical translation to improve liver fibrosis evaluation.

Primary isolated hepatic tuberculosis mimicking small hepatocellular carcinoma: A case report

RATIONALE

Mycobacterium tuberculosis (TB) remains a serious threat in developing countries. Primary isolated hepatic tuberculosis is extremely rare. Because of its non-specific imaging features, noninvasive preoperative imaging diagnosis of isolated hepatic tuberculoma remains challenging.

PATIENT CONCERNS

A 48-year-old man was admitted to our hospital due for suspected liver neoplasm during health examination.

DIAGNOSES

The tests for blood, liver function, and tumor markers were within normal range. Preoperative ultrasonography (US) showed a hypoechoic lesion with a longitudinal diameter of 2.5 cm in segment six of liver. It exhibited early arterial phase hyperenhancement and late arterial phase rapid washout in contrast-enhanced US. It demonstrated hyperintensity in T2-weighted magnetic resonance imaging and partly restricted diffusion in diffusion-weighted imaging. For this nodule, the preoperative diagnosis was small hepatocellular carcinoma (HCC).

INTERVENTIONS

Laparoscopic hepatectomy was performed. Intraoperative extensive adhesion in the abdominal cavity and liver was found. The lesion had undergone expansive growth.

OUTCOMES

Microscopically, a granuloma with some necrosis was detected. With both acid-fast staining and TB fragment polymerase chain reaction showing positive results, TB was the final histology diagnosis. After surgery, the patient declined any anti-TB medication. During the follow-up, he had no symptoms. In the sixth month after surgery, he underwent an upper abdominal US. It showed no lesions in the liver.

LESSONS

Because of non-specific imaging findings and non-specific symptoms, a diagnosis of isolated hepatic TB is difficult to make, especially for small lesions. A diagnosis of HCC should be made cautiously when small isolated lesions in the liver are encountered, especially in patients without a history of hepatitis and with negative tumor markers.

Role of Contrast-Enhanced Ultrasound (CEUS) in the Diagnosis of Cervical Lymph Node Metastasis in Nasopharyngeal Carcinoma (NPC) Patients

Objective: The aim of the study was to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in distinguishing between benign and malignant cervical lymph nodes in patients with nasopharyngeal carcinoma (NPC).

Material and Methods: A total of 144 NPC patients with enlarged superficial cervical lymph nodes underwent CEUS examination. The comparison of CEUS image characteristics between malignant and benign cervical lymph nodes was performed in this study as well. We analyzed parameters of the time–intensity curve (TIC), which includes time to peak (TP), area under the gamma curve (AUC), and peak intensity (PI). Furthermore, receiver operating characteristic (ROC) curve analysis was also investigated to evaluate the diagnostic value of CEUS.

Result: We conducted 144 lymph node examinations in total, where 64 cases were biopsy-proven benign nodules and 80 cases were biopsy-proven metastatic nodules. The vast majority of the benign nodes displayed centrifugal perfusion (96.88%, 62/64) and homogeneous enhancement (93.75%, 60/64), while most of the malignant nodes showed centripetal perfusion (92.50%, 74/80) and inhomogeneous 80.00% (64/80). In addition, quantitative analysis showed that CEUS parameters including PI, TP, and AUC in benign lymph nodes (12.51 ± 2.15, 23.79 ± 11.80, and 1110.33 ± 286.17, respectively) were significantly higher than that in the malignant nodes (10.51 ± 2.98, 16.52 ± 6.95, and 784.09 ± 340.24, respectively). The assistance of the three aforementioned parameters and CEUS image characteristics would result in an acceptable diagnostic value.

Conclusion: Our results suggest that imaging perfusion patterns as well as quantitative parameters obtained from CEUS provide valuable information for the evaluation of cervical lymph nodes in NPC patients.

Real time SVD-based clutter filtering using randomized singular value decomposition and spatial downsampling for micro-vessel imaging on a Verasonics ultrasound system

Singular value decomposition (SVD)-based clutter filters can robustly reject the tissue clutter as compared with the conventional high pass filter-based clutter filters. However, the computational burden of SVD makes real time SVD-based clutter filtering challenging (e.g. frame rate at least 10-15 Hz with region of interest of about 4 × 4 cm²). Recently, we proposed an acceleration method based on randomized SVD (rSVD) clutter filtering and randomized spatial downsampling, which can significantly reduce the computational complexity without compromising the clutter rejection capability. However, this method has not been implemented on an ultrasound scanner and tested for its performance. In this study, we implement this acceleration method on a Verasonics scanner using a multi-core CPU architecture, and evaluate the selections of the imaging and processing parameters to enable real time micro-vessel imaging. The Blood-to-Clutter Ratio (BCR) performance was evaluated on a Verasonics machine with different settings of parameters such as block size and ensemble size. The demonstration of real time process was implemented on a 12-core CPU (downsampling factor of 12, 12-threads in this study) host computer. The processing time of the rSVD-based clutter filter was less than 30 ms and BCRs were higher than 20 dB as the block size, ensemble size and the rank of tissue clutter subspace were set as 30 × 30, 45 and 26 respectively. We also demonstrate that the micro-vessel imaging frame rate of the proposed architecture can reach approximately 22 Hz when the block size, ensemble size and the rank of tissue clutter subspace were set as 20 × 20 pixels, 45 and 26 respectively (using both images and supplementary videos). The proposed method may be important for real time 2D scanning of tumor microvessels in 3D to select and store the most representative 2D view with most abnormal micro-vessels for better diagnosis.

The Value of CEUS in Distinguishing Cancerous Lymph Nodes From the Primary Lymphoma of the Head and Neck

Aim: The purpose of this study was to assess the ability of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of cancerous lymph nodes.

Methods: Contrast-enhanced ultrasonography was performed in the cervical nodules of included patients, and the diagnoses were confirmed by pathological examination. Contrast-enhanced ultrasonography images and parameters of head and neck lymphomas were compared with those of cancerous lymph nodes. Besides, receiver operating characteristic curve was operated to access the diagnostic value of CEUS.

Results: Finally, a total of 63 head and neck lymphomas and 80 cervical cancerous lymph nodes were enrolled in this study. Results showed that the CEUS images of lymphoma were mainly characterized by homogeneous enhancement (71.43%), and approximately half of them were centripetal perfusion (58.73%), whereas most CEUS images of cancerous lymph nodes were inhomogeneous enhancement (82.50%) and centripetal perfusion (92.50%). Quantitative analysis of CEUS parameters indicated that PI (derived peak intensity) and AUC (area under the curve) of lymphomas were both lower than those of cancerous lymph nodes (PI: 8.78 vs. 10.51, AUC: 652.62 vs. 784.09, respectively) (P < 0.05). Receiver operating characteristic analysis showed that the sensitivity of CEUS parameters in the differential diagnosis was significant (80.00%), although the specificity was not high (47.62%). When parameters were combined with the image features, the accuracy of diagnosis was greatly improved (from 0.655 to 0.899).

Conclusion: Contrast-enhanced ultrasonography could be a promising tool for the differential diagnosis of head and neck lymphomas and cancerous lymph nodes.

Quantitative Inflammation Assessment for Crohn Disease Using Ultrasensitive Ultrasound Microvessel Imaging: A Pilot Study

OBJECTIVES

Crohn disease (CD) is a chronic inflammation in the digestive tract that affects millions of Americans. Bowel vascularity has important diagnostic information because inflammation is associated with blood flow changes. We recently developed an ultrasensitive ultrasound microvessel imaging (UMI) technique with high vessel sensitivity. This study aimed to evaluate the feasibility of UMI to assist CD detection and staging.

METHODS

Ultrasound microvessel imaging was performed on 76 bowel wall segments from 48 symptomatic patients with CD. Clinically indicated computed tomographic/magnetic resonance enterography was used as the reference standard. The vessel-length ratio (VLR, the number of vessel pixels in the bowel wall segment normalized to the segment length) was derived in both conventional color flow imaging (CFI) and UMI to quantitatively stage disease activity. Receiver operating characteristic curves were then analyzed between different disease groups.

RESULTS

The VLR-CFI and VLR-UMI detected similar correlations between vascularization and disease activity: severe inflammation had a higher VLR than normal/mildly inflamed bowels (P < .05). No significant difference was found between quiescent and mild CD due to the small sample size. The VLR-CFI had more difficulties in distinguishing quiescent versus mild CD compared to the VLR-UMI. After combining the VLR-UMI with thickness, in the receiver operating characteristic curve analysis, the areas under the curves (AUCs) improved to AUC₁ = 0.996 for active versus quiescent CD, AUC₂ = 0.978 for quiescent versus mild CD, and AUC₃ = 0.931 for mild versus severe CD, respectively, compared to those using thickness alone (AUC₁ = 0.968; P = .04; AUC₂ = 0.919; P = .16; AUC₃ = 0.857; P = .01).

CONCLUSIONS

Ultrasound microvessel imaging offers a safe and cost-effective tool for CD diagnosis and staging, which may potentially assist disease activity classification and therapy efficacy evaluation.

Associations of serum magnesium levels and calcium-magnesium ratios with mortality in patients with coronary artery disease

AIMS

Low magnesium (Mg) and high calcium (Ca) levels are linked to increased cardiovascular disease (CVD) risk in the general population. This prospective study assessed whether there are any independent associations of serum Mg levels and Ca-Mg ratios with mortality in patients with coronary artery disease (CAD).

METHODS

This prospective cohort study included 3380 CAD patients. Cox regression models were used to estimate associations of serum Mg and Ca-Mg ratio with risk of mortality.

RESULTS

A total of 562 deaths (331 due to CVD) were recorded during a 7.59-year (median) follow-up. Spline plots displayed U-shaped associations between serum Mg levels and Ca-Mg ratios and risk of mortality. When compared with a moderate group, adjusted hazard ratios (95% confidence intervals) for low Mg levels and high Ca-Mg ratios were 1.59 (1.30-1.95) and 1.31 (1.06-1.61) for all-cause mortality, and 1.71 (1.32-2.22) and 1.44 (1.09-1.89) for CVD mortality, respectively. There was also a tendency to increase risk of mortality in patients with high serum Mg levels and low Ca-Mg ratios. Associations of low serum Mg and high Ca-Mg ratio with risk of mortality did not change when stratified by gender, body mass index, CAD type, estimated glomerular filtration rate, use of diuretics, or history of diabetes or hypertension.

CONCLUSION

This study demonstrated that a moderate Ca-Mg ratio (range: 3.91-4.70) had the lowest mortality risk, and that low serum Mg and high Ca-Mg ratio were independent risk factors of mortality in CAD patients. Nevertheless, the optimal dose-response of Mg and Ca for mitigating CAD risk still requires further investigation.

Ultrasensitive Ultrasound Microvessel Imaging for Characterizing Benign and Malignant Breast Tumors

Tumor angiogenesis plays an important role during breast tumor growth. However, conventional Doppler has limited sensitivity to detect small blood vessels, resulting in a large overlap of Doppler features between benign and malignant tumors. An ultrasensitive ultrasound microvessel imaging (UMI) technique was recently developed. To evaluate the performance of UMI, we studied 44 patients with 51 breast masses. Tumor pathology served as the gold standard: 28 malignancies and 23 benignities. UMI provided a significant improvement in depicting smaller vessels compared with conventional Doppler. The microvessel morphologies observed on UMI were associated with tumor benign/malignant classification. The diagnostic accuracy of correct Breast Imaging Reporting and Data System (BI-RADS) classification rate (BI-RADS ≥4a: test positive; BI-RADS ≤3: test negative) as a fraction of total mass population was improved by 16% after combining conventional ultrasound with UMI compared with using conventional ultrasound alone. This improvement indicates the potential of UMI in reducing unnecessary benign biopsies and avoiding missed malignant biopsies.

Intrahepatic mass-forming cholangiocarcinoma growing in a giant hepatic hemangioma: A case report

RATIONALE

Hepatic hemangioma (HH) is a common benign tumor with a high number of normal or abnormal blood vessels. Intrahepatic cholangiocarcinoma (ICC) is a relatively common malignant primary hepatic carcinoma (10%-15%) with high incidence rate and high fatality, yet low discovery rate in the early stages. Ultrasonography (US), computed tomography, and magnetic resonance imaging (MRI) are frequently used and indispensable imaging techniques for the diagnosis of hepatic lesions. It is possible to differentiate a liver lesion from HH with high accuracy owing to their different patterns and hemodynamic characteristics.

PATIENT CONCERNS

A 59-year-old Asian woman was referred to hospital for a hepatic mass, which was 9.0 × 6.5 cm in size, The patient was tested positive for hepatitis B antigen but negative for serum alpha-fetoprotein and carbohydrate antigen 199 and had a slightly elevated carcinoembryonic antigen level (3.56 ng/ml).

DIAGNOSIS

Liver US and MRI were performed. Grey-scale US revealed a huge heterogeneous mass on the right lobe with a point and line-like blood flow signal on Doppler US. Dynamic contrast-enhanced MRI showed heterogeneous annular nodular enhancement in the arterial phase. An initial diagnosis of HH was made based on the clinical history and imaging results; however, histopathologic examination of the liver lesions revealed modest to severe atypical hyperplasia of intrahepatic bile duct epithelium, cancerization, and mid to high differentiated mass-forming type cholangiocarcinoma combined with focal organized hemangioma.

INTERVENTIONS

The intrahepatic mass-forming cholangiocarcinoma (IMCC) lesion was considered a focal organization of hemangioma during operation and was surgically removed. No routine chemotherapy was performed after the operation.

OUTCOMES

The IMCC recurred 23 months after surgery, with elevated serum CA19-9 and CA125. Liver damage was evident, and the patient developed jaundice. The patient was discharged without active treatment and died in 4 months.

LESSONS

Although preoperative imaging of focal hepatic lesions is indispensable, intraoperative frozen section analysis and histopathological examination remain essential for definitive diagnosis. This is particularly important for high-risk patients and those with suspected malignancy.

Nodular focal fat sparing of liver mimicking hepatocellular carcinoma in contrast-enhanced ultrasound: A case report

INTRODUCTION

Focal fatty sparing is a manifestation of fatty liver. Nodular focal fatty sparing of liver sometimes is a mimicker of malignant lesion, especially metastatic tumor. There are some case reports about this kind of tricks revealed by computed tomography (CT) and magnetic resonance imaging. However, few reports described nodular focal sparing of liver presenting an enhancement mode of hepatocellular carcinoma (HCC) in contrast-enhanced ultrasound (CEUS).

PATIENT CONCERNS

A 37-year-old male had a long history of alcohol abuse and hepatitis B virus infection. Routine blood examination showed an elevation of triglyceride, and tumor markers were unremarkable. Conventional ultrasound indicated a diffuse fatty liver with a hypoechoic nodular lesion. CEUS revealed hyperenhancement in arterial phase and washout in late phase of this hypoechoic lesion. Contrast-enhanced CT showed a similar enhancement mode of the mass with CEUS.

DIAGNOSIS

A clinical diagnosis of HCC was made. Then, liver resection was conducted. Postoperative histopathologic and immunohistochemical results of the lesion revealed no presence of tumor cells except for heterogeneous hepatic steatosis. So a final diagnosis of hepatic focal fatty sparing was determined.

INTERVENTIONS

Liver resection was conducted according to the clinical diagnosis of HCC.

OUTCOMES

After general postoperative administration, the patient was told to discharge. Then, he had been undergoing regular serological tests and imaging examinations in our hospital for 39 months and found no manifestation of liver tumor.

CONCLUSION

According to guidelines, it is typical that hepatic focal fatty change (FFC) presents a mode of persistent iso-enhancement in CEUS. However, atypical enhancement presence of FFC in imaging examinations may occur and lead to misdiagnosis, which calls for more attention.

Ultrasonographic findings of intrahepatic lymphoepithelioma-like cholangiocarcinoma associated with Epstein-Barr virus: Two cases report

RATIONALE

Epstein-Barr virus (EBV)-related lymphoepithelioma-like cholangiocarcinoma (LELCC) is an extremely rare primary liver tumor with nonspecific clinical manifestations. The clinicopathological features of EBV-associated LELCC have been reported in a few cases. But reports of the tumor's imaging characteristics, particularly ultrasonographic findings, are very rare.

PATIENT CONCERNS

The first patient was a 64-year-old man with left upper quadrant pain and no nausea and dizziness for about 3 months. The second patient was a 40-year-old man, had an incidental finding of a hepatic tumor in a routine health checkup at a local hospital.

DIAGNOSES

In the first patient, the abdominal ultrasound demonstrated a slightly heterogeneous hypoechoic nodule in segment 3 of the liver. The nodule was about 2.0 cm × 1.7 cm in size, with a clear margin and regular shape. Color Doppler flow imaging (CDFI) revealed no blood flow signals in this nodule. According to the clinical information and imaging features, it was difficult to determine the diagnosis of the nodule. In the second patient, gray-scale ultrasound revealed a slightly heterogeneous hypoechoic mass measuring 3.5 cm × 2.5 cm with well-defined margin and regular shape at the superior segment of the left hepatic lateral lobe. There was a blurrily hypoechoic halo around the mass. In contrast-enhanced ultrasound (CEUS), the mass was homogeneous hyperenhancement in the arterial phase. In the portal phase and late phase, the center enhancement of the mass washed out gradually, presenting hypoenhancement, Therefore, the tumor was diagnosed as malignancy.

INTERVENTION

Finally, a laparoscopic left hepatic lateral lobectomy was performed in the first patient. The second patient underwent a left hepatectomy with cholecystectomy.

OUTCOMES

The first patient has been alive without recurrence or distant metastases for 11 months since the surgery. The second patient received routine follow-up after surgery. Until now, he has been tumor-free for 32 months.

LESSONS

We mainly focus on the ultrasound characteristics of EBV-associated LELCC, especially its enhancement patterns on CEUS, which may provide valuable information for diagnosis of the LELCC. When a liver tumor with typical CEUS patterns of malignancy is found in middle-aged adults with EBV positive, the possibility of EBV-related LELCC should be considered.

Ultrasonographic features of testicular metastasis from renal clear cell carcinoma that mimics a seminoma: A case report

RATIONALE

Testicular metastases from renal cell carcinoma (RCC) are extremely rare. To the best of our knowledge, only 35 cases have been described in the literatures.

PATIENT CONCERNS

A 64-year-old male presented to our urology clinic for a palpable painless mass on his right side of the scrotum by self-examination 1 week ago, with a general abdominal ultrasonographic report showing a mass in his right kidney.

DIAGNOSES AND INTERVENTIONS

Scrotal B-mode ultrasound revealed a 15 × 13 × 15 mm well-defined round homogenously hypoechoic nodule with a halo at the upper pole of the right testis. Color Doppler and spectral Doppler ultrasound detected abundant intranodular and perinodular blood flow signals including both arteries and veins. Malignancy was suspected. Abdominal contrast-enhanced computed tomography identified an irregular tumor in the posterior side of the right kidney, highly suspicious for renal carcinoma. The patient received right radical nephrectomy and right partial orchiectomy. Histologically, the right renal mass was diagnosed as RCC, clear cell type, grade 2. As to the right testicular mass, a metastasis from renal clear cell carcinoma was confirmed.

OUTCOMES

The patient has lived with no recurrence for at least 17 months without adjuvant therapy.

LESSONS

In the case, we focus on the ultrasonographic features of the testicular metastasis from RCC. Ultrasound could provide initial and helpful information for diagnosis. When finding a mass in the testicle on the ultrasound, although most of them are primary, it is important to know whether the patient has tumor history from other parts of the body. A halo may be a special feature for metastases. Contrast-enhanced ultrasound (CEUS) and ultrasonic elastography could provide more information for differential diagnoses.

Primary poorly differentiated lacrimal gland adenocarcinoma in left ocular region: A rare case report

RATIONALE

Primary poorly differentiated lacrimal gland adenocarcinoma in the orbital region is an extremely rare type of neoplasm with only 1 related case in the literature. Its high grade of malignancy makes the timely data reported necessary. Hence, we present an extremely rare disease with biopsy results and recommendations on clinical treatment in an elderly male with Chinese descent.

PATIENT CONCERNS

A 66-year-old Chinese man presented with swelling in the left ocular region and eyeball proptosis. On physical examination, the patient had redness, tenderness, and swelling of the left eye. A surgical incision was noted on the left orbital region. Left eye movements were restricted.

DIAGNOSES

Immunohistochemical examination revealed pan-cytokeratin (PCK, +), p63 (partial, +), cytokeratin 7 (CK7, +), cytokeratin 14 (CK14, +), epithelial membrane antigen (EMA, +), protein expressed by erythroblast transformation-specific related gene (ERG, -), S-100 (, -), Epstein-Barr virus-encoded small RNA (EBER, -), smooth muscle actin (SMA, -), and Ki-67 (with a proliferation index approximately 40%). After carefully reviewed the manifestations, imaging findings, and immunohistochemical evidences, a diagnosis of poorly differentiated adenocarcinoma of lacrimal gland was made.

INTERVENTION

Based on the gene sequencing results, we started the patient with an intensive PF chemotherapy including a combination of cisplatine, fluorouracil, and epirubicin. Two months later, radiotherapy was introduced to the therapy regimen.

OUTCOMES

The patient responded well to the treatment without severe adverse events. MRI scan showed remarkable remission.

LESSONS

This rare case report will help raise the awareness of high grade lacrimal gland cancer, and subsequently aid the diagnosis in future cases. Positive immunohistochemical markers of CK7, CK14, EMA, p63, and high proliferation index of Ki-67 can help establishing a diagnosis, and cisplatine-fluorouracil program is proved feasible. We share the difficulties we have encountered, hoping to improve patient care in the future.

The preliminary application of liver imaging reporting and data system (LI-RADS) with contrast-enhanced ultrasound (CEUS) on small hepatic nodules (≤ 2cm)

To evaluate the diagnostic accuracy of liver imaging reporting and data system (LI-RADS) with contrast-enhanced ultrasound (CEUS) for patients at risk for hepatocellular carcinoma with hepatic nodules (≤2cm). We retrospectively evaluated 56 CEUS exam records of hepatic nodules (≤2cm) performed between January 2015 and July 2016 at West China hospital. Each nodule was classified into a LI-RADS-CEUS category by two radiologists according to imaging features. The ultimate CEUS categories were then compared with pathological reports and their correlation was then calculated. Inter-observer agreement for LI-RADS between reader A and B was κ, 0.690, illustrating good consistency. The diagnostic accuracy of LR-5 on hepatocellular carcinoma (HCC) was 86.49% but 11.11% for LR-M. LI-RADS-CEUS is a potential standardized categorization system for high-risk HCC patients but might also increase the false-negative diagnosis of nodules of less than 2cm.

Grading fatty liver by ultrasound time-domain radiofrequency signal analysis: an in vivo study of rats

This study aimed to assess the severity of fatty liver (FL) by analyzing ultrasound radiofrequency (RF) signals in rats. One hundred and twenty rats (72 in the FL group and 48 in the control group) were used for this purpose. Histological results were the golden standard: 42 cases had normal livers (N), 30 cases had mild FL (L1), 25 cases had moderate FL (L2), 13 cases presented with severe FL (L3), and 10 cases were excluded from the study. Four RF parameters (Mean, Mean/SD ratio [MSR], skewness [SK], and kurtosis [KU] were extracted. Univariate analysis, spearman correlation analysis, and stepwise regression analysis were used to select the most powerful predictors. Receiver operating characteristic (ROC) analysis was used to compare the diagnostic efficacy of single indexes with a combined index (Y) expressed by a regression equation. Mean, MSR, SK, and KU were significantly correlated with FL grades (r=0.71, P<0.001; r=0.81, P<0.001; r=−0.79, P<0.001; and r=−0.74, P<0.001). The regression equation was Y=−4.48 + 3.20 × 10⁻²X1 + 3.15X2 (P<0.001), where Y=hepatic steatosis grade, X1 =Mean, and X2 =MSR. ROC analysis showed that the curve areas of the combined index (Y) were superior to simple indexes (Mean, MSR, SK, and KU) in evaluating hepatic steatosis grade, and they were 0.95 (L≥L1), 0.98 (L≥L2), and 0.99 (L≥L3). Ultrasound radiofrequency signal quantitative technology was a new, noninvasive, and promising sonography-based approach for the assessment of FL.

Contrast-enhanced ultrasound findings of gallbladder adenocarcinoma with sarcomatoid carcinoma accompanied by intrahepatic metastasis: A case report and literature review

RATIONALE

Gallbladder adenocarcinoma is the most common subtype of malignant tumor in gallbladder carcinoma; its incidence is quite low. Preoperative diagnosis of gallbladder adenocarcinoma appears to be very difficult because they are normally asymptomatic and are often found incidentally. Adenocarcinoma with sarcomatoid carcinoma of gallbladder is exceedingly rare with no case reported in the literature to date.

PATIENT CONCERNS

A 69-year-old male was referred to our hospital due to right upper quadrant pain. To further diagnosis, he received laboratory tests, gray-scale US, and contrast-enhanced ultrasound (CEUS). In this present study, ethical approval was not necessary, as this article is a case report, which is based on the clinical information of the patient. The patient gave his permission for publication of the case.

DIAGNOSES

Gray-scale abdominal ultrasound image demonstrated a hypoechoic intraluminal mass of gallbladder and a heterogeneous mass at the inferior segment of the right anterior liver lobe. In CEUS, the lesion of gallbladder was hyper-enhanced in the arterial phase, and hypo-enhanced in the later arterial phase. On liver, the hepatic lesion appeared heterogenous mild enhancement in the arterial phase. In portal and parenchymal phase, the hepatic lesion displayed hypo-enhancement, which conformed to the hepatic metastasis.

INTERVENTIONS

The patient received cholecystectomy, right hepatectomy, and lymphadenectomy.

OUTCOMES

He had an uneventful recovery from the procedure.

LESSONS

We presented a case report with gallbladder adenocarcinoma with sarcomatoid carcinoma accompanied by intrahepatic metastasis, focusing on the ultrasound imaging features of this tumor, especially its enhancement pattern on CEUS. CEUS provided helpful information for diagnosis. Herein, we report the case; and the associated literature is further reviewed.

Assessment of liver fibrosis by ultrasound elastography and contrast-enhanced ultrasound: a randomized prospective animal study

This study aimed to assess liver fibrosis by contrast-enhanced ultrasound (CEUS) and point shear-wave elastography (pSWE) in rabbits and compare the performance of the two techniques. Eighty rabbits were divided into experimental (n=60) and control group (n=20). In the experimental group, liver fibrosis (F1-F4) was induced by subcutaneous injection of carbon tetrachloride. CEUS and pSWE of the liver was performed for the two groups at a 4-week interval for 40 weeks. The portal vein rise time (PV-RT), time to peak (PV-TTP), mean transit time (PV-MTT) and the maximum signal intensity (PV-Imax) were analyzed with time-intensity curves (TICs). Liver stiffness value (LSV) was obtained through pSWE. Histologic examination of liver specimens of the rabbits was performed to evaluate the fibrosis stage. PV-RT, PV-TTP, PV-Imax and LSV were significantly different among five liver fibrosis stages (F0-F4) (P<0.01). PV-Imax and LSV displayed better diagnostic performance than PV-RT, PV-TTP, PV-MTT. For diagnosing≥F1 stage fibrosis, the area under the receiver operating characteristic curve (AUROC) of PV-Imax was 0.870, which was similar to that of LSV 0.874 (P=0.94). For diagnosing ≥F2, ≥F3 and ≥F4 stage fibrosis, the AUROC of PV-Imax and LSV was 0.845 vs. 0.956 (P=0.04), 0.789 vs. 0.954 (P=0.01) and 0.707 vs. 0.933 (P=0.03). Both CEUS and pSWE had the potential to be complementary imaging tools in the evaluation of liver fibrosis. The performance of pSWE may be better than CEUS.

Can ultrasound elastography identify mass-like focal fatty change (FFC) from liver mass?

Focal fatty change (FFC) may mimic liver mass on conventional B-mode ultrasound. Clinical differentiation of mass-like FFC and liver mass is important due to different clinical interventions. Contrast-enhanced imaging (CEI) or biopsy is reliable for this differentiation, but is expensive and invasive. This study aimed to explore utilities of ultrasound elastography for this differentiation.This study enrolled 79 patients with focal liver lesions (FLLs), of which 26 were mass-like FFC confirmed by at least 2 CEI modalities. The other 53 were liver masses, confirmed by pathology (n = 28) or at least 2 CEI modalities (n = 25). Lesion stiffness value (SV), absolute stiffness difference (ASD), and stiffness ratio (SR) of lesion to background were obtained using point shear-wave elastography (pSWE) and compared between FFC group and liver mass group. The performance of SV, ASD, and SR for identifying FFC from liver mass was evaluated.SV was 5.6 ± 2.4 versus 16 ± 12 kPa, ASD was 2.0 ± 1.9 versus 11 ± 12 kPa, and SR was 1.4 ± 0.6 versus 3.0 ± 1.9 for FFC and liver mass group, respectively (P < .0001). The area under the receiver operating characteristic curve of SV, ASD, and SR for discriminating mass-like FFC and liver mass was 0.840, 0.842, and 0.791, respectively (P < .05). Particularly, with cut-off ASD < 1.0 kPa, positive predictive value was 100%, specificity was 100%, and accuracy was 82% for diagnosing FFC.pSWE may be a potential useful modality for identifying mass-like FFC from liver mass, which might help reduce the necessity for further CEI or biopsy for diagnosing mass-like FFC.

Contrast-enhanced ultrasound in the therapeutic assessment of diffuse large B-cell lymphoma: A case report

Contrast-enhanced computed tomography (CECT) has been extensively used in the restaging and assessment of treatment response for diffuse large B-cell lymphoma (DLBCL). However, CECT does not provide information regarding the specific functionality of lesions. A patient (56 years old, female) was previously admitted to the present institution, with bilateral cervical masses. Following numerous cycles of chemotherapy, a stable disease status was confirmed using CECT. In conjunction with CECT imaging results, contrast-enhanced ultrasound (CEUS) demonstrated important semi-functional information regarding blood perfusion, during the revision of treatment assessment. ¹⁸F-fluoro-2-deoxyglucose (FDG)-positron emission tomography-computed tomography imaging demonstrated no increase in FDG uptake of the same tumor lesion, consistent with the results of CEUS. CEUS exhibited the potential to present complementary results to CECT, in the therapeutic assessment of DLBCL, which, to the best of our knowledge, has not previously been reported.

Safety and efficacy evaluation of pertuzumab in patients with solid tumors

BACKGROUND

The development of targeted therapies benefits patients with certain markers in the treatment of breast cancer. Pertuzumab is a novel humanized monoclonal antibody that blocks human epidermal growth factor receptor 2 (HER2) dimerization. The Food and Drug Administration has approved pertuzumab in combination with trastuzumab and docetaxel for the treatment of patients with HER2-positive metastatic breast cancer.

METHODS

To assess the safety and efficacy profile of pertuzumab, we searched PubMed and Embase (articles from January 1966 to January 2015) using the keyword "pertuzumab".

RESULTS

Fourteen eligible studies were included in our final analysis. From the results of our analysis, diarrhea (56.9%, 95% confidence interval [CI] 49.6%-63.9%), nausea (34.0%, 95% CI 27.7%-40.8%), and rash (25.6%, 95% CI 20.8%-31.0%) were the most common adverse effects in pertuzumab alone and pertuzumab-based therapies. Based on randomized controlled clinical trials, diarrhea (odds ratio [OR] 2.310, 95% CI 1.818-2.936), rash (OR 1.848, 95% CI 1.094-3.122), and febrile neutropenia (OR 1.672, 95% CI 1.130-2.474) were of statistical significance, which meant that pertuzumab played a prominent role in the incidence of diarrhea. Meanwhile, pertuzumab showed its effective role in cancer control and lifetime prolongation.

CONCLUSION

In conclusion, considering that the common adverse effects for pertuzumab are gastrointestinal and skin toxicities, which are easier to handle than other toxicities, pertuzumab is a safe and effective drug for patients with solid tumors.

A polymorphism in the OPRM1 3'-untranslated region is associated with methadone efficacy in treating opioid dependence

The mu-opioid receptor (MOR) is the primary target of methadone and buprenorphine. The primary neuronal transcript of the OPRM1 gene, MOR-1, contains a ~13kb 3′ untranslated region with five common haplotypes in European-Americans. We analyzed the effects of these haplotypes on the percentage of opioid positive urine tests in European-Americans (n = 582) during a 24-week, randomized, open-label trial of methadone or buprenorphine/naloxone (Suboxone) for the treatment of opioid dependence. A single haplotype, tagged by rs10485058, was significantly associated with patient urinalysis data in the methadone treatment group. Methadone patients with the A/A genotype at rs10485058 were less likely to have opioid-positive urine drug screens than those in the combined A/G and G/G genotypes group (Relative Risk = 0.76, 95% confidence intervals = 0.73–0.80, p = 0.0064). Genotype at rs10485058 also predicted self-reported relapse rates in an independent population of Australian patients of European descent (n = 1215) who were receiving opioid substitution therapy (p = 0.003). In silico analysis predicted that miR-95-3p would interact with the G, but not the A allele of rs10485058. Luciferase assays indicated miR-95-3p decreased reporter activity of constructs containing the G, but not the A allele of rs10485058, suggesting a potential mechanism for the observed pharmacogenetic effect. These findings suggest that selection of a medication for opioid dependence based on rs10485058 genotype might improve outcomes in this ethnic group.

Contrast-enhanced ultrasound in diagnosis of primary hepatic angiosarcoma

Primary hepatic angiosarcoma (PHA) is a rare malignant tumor that occurs mainly in the elderly, with almost no specific symptoms or tumor markers. Information on the imaging characteristics of this tumor is limited due to its rarity. Therefore, it is difficult to diagnose PHA. So far, its definite diagnosis depends on histopathologic examination combined with immunohistochemical results. Patients with PHA have a poor prognosis in spite of surgical resection of this tumor. In this case report, we present a 72-year-old woman with PHA, focusing on the imaging features of this tumor, especially its enhancement pattern on contrast-enhanced ultrasound images. Contrast-enhanced ultrasound provided helpful information for diagnosis.